Allergies and the Voice

About Dr. Reena Gupta

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at OHNI. Dr. Gupta has devoted her practice to the care of patients with voice problems. She is board certified in otolaryngology and laryngology and fellowship trained in laryngology, specializing in the care of the professional voice.

About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

Most people associate allergies with the classic symptoms seen on commercials: itchy, watery eyes; runny nose; and sneezing. However, far more often, allergies present subtly, and in a way that is quite sinister when it comes to voice: postnasal drip.

What is postnasal drip?

Postnasal drip is the term for mucous that drips down the back of the throat. Mucous forms in glands throughout the respiratory tract, and much of it forms in the nose and sinuses. The body produces a significant amount of mucous – about 1-1.5 liters per day. The vast majority of nasal mucous slides down the back of the nose, into the throat, where it is swallowed.

The symptoms of postnasal drip are noted when nasal mucous changes in quality or quantity. For example, when suffering from a cold, mucous is produced in a greater quantity. It also becomes thicker. When this drips down the back of the throat, it is sensed as postnasal drip.

Do allergies cause postnasal drip?

When an allergic reaction occurs, mucous production increases, and the contents of the mucous are more inflammatory. This is why sufferers will often wake up with a sore throat in the morning. They have been lying down all night, during which the allergic and irritating mucous has dripped into the throat, causing discomfort.

Allergies occur when the body falsely identifies a benign particle, such as dust, as a pathogen (i.e., virus or bacteria). It launches an immunologic response, including nasal inflammation and increased mucous production.

How does this affect my voice?

Allergies and postnasal drip will affect the voice in two ways:

Laryngitis – Postnasal drip results in irritating mucous contacting the vocal folds, particularly at night. This will result in vocal fold swelling (see video below). Symptoms may be severe (i.e., raspiness, decreased range) or subtle (i.e., delayed onsets, prolonged warm up time). Over time, this increases the risk of injury and may become permanent.

Decreased nasal resonance – nasal structures, called turbinates, become inflamed with chronic allergies. Turbinate inflammation results in less nasal airflow and less of a resonance chamber for sound. This makes the singer sound congested, and less resonant. Over time, this may become irreversible and require surgery.

What are turbinates?

Turbinates are long, tubular structures that extend from the front of the nose to the back. They are the nasal humidifiers, allowing environmental air to be warmed, moisturized, and filtered before entering the lungs. They are the body’s first line of defense against viruses and allergies, trapping these particles in mucous on the turbinates. Turbinates swell from allergies and cause nasal congestion, increased mucous production and decreased nasal resonance.

Can I just blow my nose to treat symptoms?

Blowing your nose will help with mucous production, but only during the day and for a small amount of mucous. The real solutions for allergic laryngitis include:

Sinus Rinse – similar to a Netti Pot (which is a good alternative for those who prefer this), this nasal irrigation system is excellent at removing the particles that cause allergy and inflammation.

Prescription nasal spray – Certain medicated nasal sprays are excellent at reducing allergic inflammation without causing laryngitis, a common side effect of many nasal sprays.

Allergy management – allergy desensitization is an excellent way to “cure” your allergies, avoiding the need for anything besides a Sinus Rinse.

Turbinate reduction surgery – If left chronically untreated, turbinates may become so swollen that conservative options do not work. In these patients, turbinate reduction surgery will improve nasal airflow, reduce postnasal drip, and reduce the frequency of infections. Care must be taken to work with a surgeon who is familiar with vocal outcomes of nasal surgery and who is partnered with a laryngologist.

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If you would like to speak with one of our physicians regarding this issue or another ear, nose, throat problem; or have other questions or concerns, please complete the contact form below or call us at 310-657-0123.

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The Best in Ear, Nose, & Throat Care

Alex Fernandez, Editor

Welcome to this online patient education journal. It is designed to provide reliable medical information in a format that is easy to understand. As Chief of Medical Resources, I hold an undergraduate degree in Neuroscience from the University of California, Los Angeles and a graduate degree in Medical Science from the University of Southern California. It is my hope that you find this to be a valuable resource.